Provider Demographics
NPI:1801586656
Name:KILLEEN VISION 153
Entity type:Organization
Organization Name:KILLEEN VISION 153
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:TAEWON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-261-7449
Mailing Address - Street 1:2100 S W S YOUNG DR STE 1000
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-5355
Mailing Address - Country:US
Mailing Address - Phone:254-261-7449
Mailing Address - Fax:254-261-7450
Practice Address - Street 1:2100 S W S YOUNG DR STE 1000
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-5355
Practice Address - Country:US
Practice Address - Phone:254-261-7449
Practice Address - Fax:254-261-7450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KILLEEN VISION 153
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty